1. education
2. high school

Dance Clinic
Registration Form
Saturday, January 31st at Blue Valley Northwest High School
8:30am – 11:30am
Please drop off in Commons. Parent preview in gym at 11:15
Perform with the DAZZLERS at 1/2 time of varsity b-ball game on Monday, February 2nd!
$25
Register by January 23rd to guarantee a shirt, or $30 at the door/after January 23rd.
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Dancer’s Name:
T-Shirt Size: (circle one)
Gender: Boy / Girl
Child:
s
m
l
xl
Adult:
s
m
l
xl
Guardian Name:
Address:
Phone Number:
Email:
Elementary School/Dance Studio:
Food allergies/Medical notes:
***Please mail this form and permission slip, along with check for $25 to Blue Valley
Northwest High School, Attn: Dazzlers – Andrea Smith, 13260 Switzer Rd, Overland Park,
KS 66213. Please make checks payable to BVNW Dazzlers. Registration must be postmarked
by January 23rd to guarantee correct t-shirt. Please note: due to bookkeeping procedures,
we can NOT offer refunds, even in the event of inclement weather. T-shirts and items will
still be distributed. Email Stacy Carey at [email protected] for questions!***
BVNW Junior Dazzlers Dance Clinic
Parental Permission Form
My child will be participating in the Blue Valley Northwest Junior Dazzlers Dance Clinic on Saturday, January
31st, 2015, and the varsity basketball performance on Monday, February 2nd.
Name of Participant_________________________________________________________________
School______________________________________________________
Grade Level________
Name of Parent/Guardian_____________________________________________________________
I, the undersigned parent/guardian do hereby grant permission for my child to participate in the Blue Valley
Northwest Junior Dazzler Dance Clinic on Saturday, January 31st, 2015, and the basketball performance on
Monday, February 2nd, 2015.
I acknowledge and understand the following:
1.
That while participating in the clinic/performance there is a possibility of illness or injury to my child. I
further acknowledge and understand that my child is assuming the risk of such physical illness and/or
injury by his/her participation, and I further release Blue Valley Northwest High School, as well as its
representatives, from any claims for personal illness and/or injury that my child may sustain as a
result of his/her participation.
2. In order that my child may receive emergency medical treatment in the event of illness or injury
during the event, I hereby authorize the school coach or Blue Valley Northwest and its
representatives to obtain medical treatment for my child for such illness or injury. I hereby hold Blue
Valley Northwest High School and its representatives harmless in the exercise of this authority. I
agree to be responsible for any and all medical bills that may be incurred on behalf of my child as a
result of his/her participation in this clinic.
3. Blue Valley Northwest High School has established rules and regulations regarding conduct, safety,
and sportsmanship by which my child must abide, and that my child and I will be responsible for
his/her failure to abide by those rules and regulations.
I have read and understand 1, 2, and 3 above, and give my permission to participate in the
clinic/performance.
Parents/Guardian’s Signature
Date Signed
Additional Information:
T-SHIRTS: Each year our shirts have a unique design, so we do not have a surplus of shirts.
Every child who participates will receive a t-shirt. Those children who register by the
January 23rd deadline will get t-shirts at the end of the clinic on January 31st. All others
will receive t-shirts prior to the performance on February 2nd.
BASKETBALL GAME: Please note; the cost of the clinic includes the DANCER’s admission to
the basketball game. This does not include a parent’s admission. (This is consistent amongst
other clinics that perform at half times as well.) For the performance, we will be facing
the West side of the gym. Be sure to bring your camera!
REFUNDS: Due to bookkeeping procedures, we CANNOT refund registration fees for any
reason (i.e. illness, last minute changes to plans, etc). However, if something comes up,
please contact sponsor Andrea Smith and she will make your Junior Dazzler’s t-shirt and
goodies available for pick-up in the BVNW office until February 6th after school. Items will
have the Junior Dazzler’s name on them. After February 6th, items will no longer be
available for pick up.
TRADITION AFTER THE PERFORMANCE: After the basketball performance, there is an
optional tradition for the Junior Dazzlers ask the BVNW Dazzlers to autograph their shirts.
The big Dazzlers will make themselves available for this after the halftime performance in
the commons during child pick-up. Please bring a Sharpie/permanent parker for this
occasion if your Jr. Dazzler wishes to participate.